BestNotes Insurance Billing and Electronic Claims Review

Modified on: Thu, Aug 2, 2018 at 4:36 PM

Overview

This document is intended to help you, a BestNotes customer, determine whether BestNotes’ billing and claims capabilities are a fit for your company’s claims needs and billing workflows. A BestNotes Electronic Claims Checklist is available at the bottom of this document.

It is important to understand that BestNotes staff are not billing specialists and cannot perform any billing setup without guidance from your billing staff. No custom development for billing and claims management can be accommodated at this time for our current product. However, we intend to build full billing functionality into our in-development product code-named BestNotes Fresh.

BestNotes Service Tracking

One of BestNotes’ major strengths is documenting services rendered. Clinical service codes can be registered in a client’s ledger in a variety of ways, both automatically and manually. All BestNotes claims are driven by these client ledger entries.

Each ledger entry is linked to a date of service, rendering provider and facility (billing provider or service facility). In order for claims to be generated, additional items such as diagnosis, rendering provider details, and payer and plan information must be configured in advance. This information can then be pulled together to generate standard 837 electronic claims as EDI files. These files are then sent via secure FTP to one of our three billing service partners: EZClaim, ClaimMD, or Office Ally. If you currently working with a third-party billing service that supports secure FTP, let us know, and we can investigate a connection.

Claims in BestNotes

BestNotes provides several mechanisms for creating claims from services. Customers who bill professional (HCFA/837p) claims may preview all unbilled services across all clients through the Preliminary Claims Queue (PCQ). The PCQ will alert to common claim-related issues and allows for minor service edits. All claims generated from this view are sent with one service per claim.

Another mechanism for working with claims is the BestNotes Claims Manager. From the Claims Manager you can review sent claims and edit already created, but unsent claims. You can also create new claims against patient services one patient at a time. This is also the only mechanism able to create institutional claims (UB04/837i). Institutional claims cannot be generated in bulk.

The heavy lifting of managing existing claims including edits, printing and status checks are done through our billing service partners. Patient statements and ledger reconciliation must be done manually except in the case of EZClaim which supports both. BestNotes does provide service line tracking or statement of services through a register/ledger report filterable by date.

BestNotes Electronic Claims Checklist

☐ I bill mainly professional (HCFA/837p) claims with no or low-volume institutional (UB04/837i) claims☐ I don’t mind creating my expected volume of institutional claims one patient at a time☐ I don’t need to auto-reconcile back to the BestNotes client ledgers☐ I understand that the only BestNotes billing partner that facilitates AR/client statements is EZClaim☐ If I want to use Office Ally, I understand that they do not support mixed (HCFA/UB04) claims through BestNotes☐ My payers don’t require different codes or credentials for the same service☐ I don’t regularly make edits to services prior to generating claims☐ I don’t have complicated rendering/supervising provider requirements (BestNotes does allow for sending both, and can substitute supervising for rendering in limited ways)☐ I understand that all edits on sent claims and/or special payer adjustment rules must happen within my billing service vendor solution, e.g. EZClaim, and not within BestNotes☐ I don’t need to back-bill for any services

Getting started

If after a review of this document you feel that BestNotes’ current billing functionality is a potential fit, contact one of our service partners below. Once you’ve decided on a vendor or if you have any further questions, please contact us at (208) 543-6646. If you’ve decided to work with Office Ally or ClaimMD, please have your SFTP credentials available for the phone call with BestNotes.